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WATER , SANITATION AND HYGIENE


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SITUATIONLack of water and sanitation is one of the biggest issues affectingthe health of children across Cambodia, particularly those wholive in the countryside. Too many children are still denied themost basic rights to safe water, the dignity of using a toiletand the simple practice of washing hands with soap. Theconsequences for children are severe, as high occurrences ofdiarrhoea, skin disease, respiratory illnesses such as pneumonia,intestinal and other waterborne and excreta-related diseases casta shadow over child health and in many cases, result in death.High incidences of diarrhoeal diseases alone account for one fthof the deaths of children age ve and under in Cambodia, andan estimated 10,000 overall deaths annually, largely owing to lackof sanitation and poor hygiene practices.

Improving hygiene through use of latrines and handwashing with soap, protecting water sources from faecalcontamination, ensuring sustainable sources of water,as well as monitoring water quality remain key challenges

for Cambodia.Disparities in access to water and sanitation between urbanand rural areas, across and within provinces and amongdifferent wealth groups are clear. People living in urban areasof the country have three times more access to sanitation thanthose living in rural and peri-urban areas, diarrhoea prevalenceis ve times greater in some regions than others, and the richhave 22 times more access to piped water than the poor.

UNICEF believes there are many solutions to these issuesand is working with the government to harness innovativeapproaches and new ideas to address the long-standingproblems of low sanitation coverage, unsustained usageof toilets and poor water quality. However, more must be done

to put these solutions into action through initiatives that build

KEY PARTNERSHIPS IN WATER,SANITATION AND HYGIENE

UNICEF works closely with the government tosupport the national strategy for rural water supply,sanitation and hygiene. Our main government

partners in this area are: Ministry of Rural Development Ministry of Health Ministry of Education, Youth and Sport

UNICEF contributes to national coordination effortsthrough its role as the lead development partnerfacilitator in the Technical Working Group for RuralWater Supply, Sanitation and Hygiene, led by theMinistry of Rural Development.

Other key partners include the World HealthOrganization, World Bank, Asian Development Bank

and local and international NGOs.

the capacity of local people to ensure these basic servicesand facilities are available, affordable and appropriate, andthat they remain operational over the long-term.

UNICEF promotes a package of appropriate, affordable sanita-tion, water and hand washing facilities in schools, health centresand households, which meet the specic needs of communities.UNICEF programmes promote water, sanitation and hygieneladders, which introduce basic technologies that may beupgraded when families can afford to do so.

MILLENNIUM DEVELOPMENT GOAL 7:ENSURE ENVIRONMENTAL SUSTAINABILITYUNICEFs work on water, sanitation and hygienecontributes to achieving target 3 of MDG 7: to halve,by 2015, the proportion of people without sustainableaccess to safe drinking water and basic sanitation.

Increasing water and sanitation access for the poorhas a fundamental impact on MDG measures relatedto poverty, gender equality, health and education.


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IMPROVING CAPACITY TO DELIVER ON WATER, SANITATION AND HYGIENESustainable improvements in hygiene behaviour patternsrequire more than education activities. At the same time,water, sanitation and hygiene facilities are not sufcienton their own to improve health.

Over the years, UNICEFs work on water, sanitation andhygiene has shifted from an emphasis on provision of watersupply hardware such as hand pumps and wells to a moreholistic approach that combines provision of facilities withthe promotion of behaviour change and supportive policiesand institutions.

The development of policies, institutions and communitycapacity to manage and sustain hygiene, water and sanitationprogrammes is essential for long-term success. In Cambodia,UNICEF works with the government and other partners to

create conditions for change or enabling environments to ensure the effectiveness and sustainability of all water,sanitation and hygiene efforts.

Communities must be equipped with the knowledge andskills to effectively manage their own facilities and to demandhigh-quality services from government, civil society and theprivate sector.

Engagement of the private sector through sanitation marketingwill encourage local producers to design and sell affordablesanitation facilities to households, avoiding the need for directsubsidies to households.

This model has been shown to be effective in areas where

communities have been mobilised through communityempowerment and participatory approaches like community-led total sanitation. This helps to free the limited resourcesof government and development partners to focus on thepoorest and unreached areas, ensuring quality and appropriateproducts and services are available to all.

UNICEF works with the government at national, provincial andlocal levels to develop their capacity to deliver water, sanitationand hygiene services. Governments are encouraged to developnational strategies that are tailored to local priorities andneeds, whilst addressing in particular the interestsof the poor.

WHAT WE DOSupport capacity development of the provincial and locallevel government to develop action plans to operationalizethe national rural water supply, sanitation and hygiene strat-egy to effectively deliver on water, hygiene and sanitation.

Together with partners, strengthen national capacitiesto use monitoring in policy development, planning andresource allocation.

Build the capacity of the government to collect and dissemi-nate accurate information on access to water and sanitationservices, including disaggregated information on levels ofaccess by vulnerable and marginalised groups.

Advocate for an increase in government resources bydemonstrating the economic and social benets ofinvestment in water, sanitation and hygiene.

Continue to advocate for open markets and opportunitiesfor sanitation marketing so that affordable sanitation optionsare made available to households.

Support the government to establish appropriate regulatorymechanisms to create a competitive environment that willattract private sector service providers to invest in water,sanitation and hygiene improvements in the country.

IMPACTUNICEF has contributed signicantly to policy dialoguesthat have led to the establishment of the Technical WorkingGroup on Rural Water Supply, Sanitation and Hygiene in2007, the development of a National Strategic Action Planfor Arsenic Mitigation, and a National Strategy for RuralWater Supply, Sanitation and Hygiene in 2010.

A sub-decree on National Sanitation Day signed by thePrime Minister in 2010 and a joint Prakas (Declaration)between the Ministry of Rural Development and theMinistry of Education, Youth and Sport on school and

community sanitation and hygiene were also key resultsof intensive collaboration with UNICEF.

These initiatives have led to stronger leadership of theMinistry of Rural Development in coordinating and leadingthe rural water supply, sanitation and hygiene sector.


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PROMOTING KEY HYGIENE BEHAVIOURSCreating clean environments for children averts threats totheir health and supports the best chance at a prosperous life.Less than 1 in 3 Cambodians have access to latrines and handwashing facilities, one of the lowest rates in Southeast Asia.

According to the World Health Organization diarrhoea continuesto be the second leading cause of death among children inEast Asia. Nearly 70 per cent of Cambodias rural population

roughly 6.4 million people still practice open defecation astheir principle sanitation option. Findings from a 2010 NationalSanitation and Hygiene Survey show that only 31.8 per centof Cambodians use latrines, only 16.7 per cent of Cambodianshave a xed hand washing place in their homes and only 62 percent of respondents reported practising hand washing. Yet, theuse of a toilet can decrease diarrhoeal deaths by 30 per cent andhand washing with soap by more than 40 per cent.

UNICEFs hygiene awareness and promotion efforts focuson changing behaviour by communicating key hygienepractices such as hand washing with soap, using toilets,treating and drinking safe water. UNICEF works with nationaland local governments and village leaders to create healthyenvironments for children that prevent water-borne diseasesby leveraging local resources and community solutions topromote good hygiene behaviours.

Children and youth are encouraged to be agents of changein their families and communities through initiatives such aslife skills training programmes, curriculum development andintegrated sanitation and hygiene education in schools.

Sustainable sanitation technology options are required forareas in the country that are prone to ooding and have

a high water table and/or unstable soils. In these areas,

conventional technologies like dry pit latrines are not suitableor socially appropriate, often leading to the preferencefor open defecation, which leads to the contamination ofprecious water sources. UNICEF and development partnersare working to nd affordable or cost-effective solutions,which address needs in challenging environments whilst stillprotecting precious natural resources.

In an effort to reduce disease and child mortality, UNICEFsupports the Cambodian Government in mobilizingcommunities to build their own latrines and attain OpenDefecation Free status that reduces the risk of diarrhoealdiseases associated with faecal-contaminated water. Studiesprove that encouraging use of latrines and reducing oreliminating open defecation is more effective in curbing therate of child diarrhoea than simply improving the water supply.

COMMUNITY-LED TOTAL SANITATIONCommunity-led total sanitation is an approach ledby the community to achieve better sanitation.Communities are supported by trained facilitatorsto analyse the sanitation situation of their villagesand to engender commitment and create actionplans to become Open Defecation Free and to dothis through their own efforts.

This approach fosters innovation and commitmentwithin the community and motivates people to buildtheir own sanitation infrastructure, without dependingon external nancial or material assistance.


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WHAT WE DOSupport hygiene awareness and education in schools,health centres and households through constructionand/or promotion of latrines and hand washing facilitiesand appropriate treatment and storage of drinking water,and advocate for the government to ensure thesebecome standard facilities in all schools, health centresand households.

Support the development of community facilitators at thelocal level who are equipped with skills and the necessarypromotional materials on sanitation and hygiene to motivatebehaviour change and engender commitment withincommunities.

Continue to focus on safe and affordable sanitation inhouseholds by supporting community-based approachessuch as the community-led total sanitation approach tomobilize communities to attain Open Defecation Free statusto prevent contamination of water sources.

Support Commune Councils to sustain Open DefecationFree status through commune and village monitoringsystems, to develop communication strategies to provideinformation and education on good sanitation and hygienein the community, and to raise awareness on sanitation andhygiene issues through events, including World Water Day,National Sanitation Day and Global Hand washing Day.

Explore appropriate and affordable options for poor families

to get affordable and sustainable sanitation technologies.Globally, partnerships for sustainable sanitation technologiesare growing and UNICEF aims to facilitate this knowledgetransfer in the context of Cambodia.

IMPACTCleaner environments translate into optimal living andlearning conditions for children. According to the 2009/2010Education Management Information System, approximately79.3 per cent of primary schools had latrines that improvedchildrens ability to focus on learning. In addition, since2006, approximately 20 per cent of 4,140 villages haveimplemented the community-led total sanitation approachwithout outside nancial or material support. Of these, 50per cent have declared Open Defecation Free status,meaning every family has built and used their own latrines.An evaluation conducted in 2009 conrmed that community-led total sanitation is effective in raising awareness and

motivating communities to stop open defecation. Effortswill continue to sustain the results through promotion ofsanitation marketing, ensuring availability of affordablesanitation options and strengthening hygiene promotion,particularly hand washing with soap at critical times.


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IMPROVING WATER SUPPLIESIn Cambodia, access to safe and sustainable drinking waterand adequate sanitation and hygiene facilities remains a chal-lenge, particularly for families in rural areas. Polluted ponds andrivers remain the main source of water for cleaning, bathingand drinking, and access to latrines and hand washing facilitiesin the home and at school are limited.

Although an increasing number of rural households aresecuring adequate water supplies, ensuring water qualityis a challenge. Water contaminated by faeces or polluted asa result of mining and other industrial activities can lead toillness and death among children. Through the promotionof locally produced ceramic lters and sand lters that cantreat water contaminated with bacteria, solutions have beenfound to obtain clean water in the home. Combined with thepromotion of good household storage of water and regularhand washing with soap, this has been shown to be effectivein reducing cases of diarrhoea.

Meanwhile, naturally occurring water contaminants, suchas arsenic, continue to poison Cambodias water supply,especially in the lowland areas around the Mekong River andits major tributaries. Because it has no taste or smell, arsenicis an especially dangerous and invisible poison that can causea series of irreversible health complications, including cancerof the skin, lungs, bladder and kidneys, as well as skin lesionsand changes in pigmentation.

An estimated 1,600 villages in six provinces and in parts ofPhnom Penh have been identied as being at risk of arseniccontamination in their water supplies. Approximately 2.25million people live in these areas.

UNICEF works with the government and developmentpartners to seek effective means for regular and routinetesting of water sources, followed by marking or closingwells that are deemed unsafe and promotion of alternativewater sources, such as rainwater harvesting or pipe systems.UNICEF has piloted rainwater technologies using locallyavailable materials, which allow water to be collected in aseries of local jugs. This decreases the work load on womenand children, while increasing the quantity of potentially safewater available for drinking.


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WHAT WE DOSupport government efforts in implementing a nationalstrategy for rural water supply, sanitation and hygiene,featuring programmes that promote community-basedmanagement of improved sources of drinking water, suchas establishing simple water safety plans, promotinghousehold water treatment and safe storage, and privatesector involvement in provision of services. Support is alsoextended to primary schools and health centres to ensureadequate water supply for drinking and hand washing.

Support the governments National Strategic Action Planfor Arsenic Mitigation, which tests wells for contamination

and educates communities about the dangers of arsenic.In addition, affected communities receive assistance inestablishing alternative water sources, such as small-scalepiped water systems, rainwater tanks, ceramic water ltersand shallow wells.

Advocate for commune councils to strengthen communityengagement in water supply improvement through Waterand Sanitation Users Groups focused on promoting useand maintenance of water facilities and protection of watersources and the surrounding environment.

Promote the use of user-friendly, affordable and simplewater quality test-kits that make it possible for communi-ties to evaluate their own water sources and carry out

evidence-based negotiations with the authorities. This isalso an opportunity for empowering communities to notonly inform authorities of shortcomings, but also to notifyother community members when water quality is poorand other steps that need to be taken for basic householdwater treatment.

IMPACTAn increasing number of communities are successfullyreducing disease through increased access to well-maintained toilets, hand washing facilities, and safeand sustainable drinking water. Since 1983, some21,000 new wells have been built in Cambodia, providingapproximately 420,000 families with safe drinking water.A national strategic plan for arsenic mitigation has led toearly detection, with testing of 37,280 wells in high-riskprovinces completed by the end of 2009.

Moreover, children are bene ting from improved learningenvironments as approximately 66.1 per cent of primaryschools in the 2009/2010 school year secured access toclean water. Access to improved sanitation facilities atschool has also improved attendance, especially for girls.


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UNICEF CAMBODIA

P.O. Box 176, Phnom Penh

Tel: +855 (0)23 426 214

e-mail: [email protected]

www.unicef.org/cambodia

All photos by: UNICEF Cambodia/Nicolas Axelrod | Designed by Quinin Lab: www.quininlab.com

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